Provider Demographics
NPI:1992759609
Name:DEPAUL, JEFFREY EUGENE (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EUGENE
Last Name:DEPAUL
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24160 STATE ROAD #54
Mailing Address - Street 2:UNIT #5
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559
Mailing Address - Country:US
Mailing Address - Phone:813-997-6942
Mailing Address - Fax:813-948-0788
Practice Address - Street 1:24160 STATE ROAD #54
Practice Address - Street 2:UNIT #5
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-997-6942
Practice Address - Fax:813-948-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health